TY - JOUR
T1 - In-hospital major bleeding during st-elevation and nonst-elevation myocardial infarction care
T2 - Derivation and validation of a model from the action registry®-GWTG™
AU - Mathews, Robin
AU - Peterson, Eric D.
AU - Chen, Anita Y.
AU - Wang, Tracy Y.
AU - Chin, Chee Tang
AU - Fonarow, Gregg C.
AU - Cannon, Christopher P.
AU - Rumsfeld, John S.
AU - Roe, Matthew T.
AU - Alexander, Karen P.
N1 - Funding Information:
The Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines (ACTION Registry–GWTG) is an initiative of the American College of Cardiology Foundation, Washington, District of Columbia, and the American Heart Association, Dallas, Texas, with partnering support from Society of Chest Pain Centers , Dublin, Ohio, the Society of Hospital Medicine , Philadelphia, Pennsylvania, and the American College of Emergency Physicians , Irving, Texas. The registry is sponsored by Bristol-Myers Squibb (New York, New York)/ Sanofi Pharmaceuticals (St. Louis, Missouri). This project received infrastructure support from the Agency for Healthcare Research and Quality , Rockville, Maryland, under grant U18HS016964 . The content is solely the responsibility of the investigators and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The funding source had no role in the design or implementation of the study or in the decision to seek publication.
PY - 2011/4/15
Y1 - 2011/4/15
N2 - Bleeding, a common complication of acute myocardial infarction (AMI) treatment, is associated with worse outcomes. A contemporary model for major bleeding associated with AMI treatment can stratify patients at elevated risk for bleeding and is needed to risk-adjust AMI practice and outcomes. Using the Acute Coronary Treatment and Intervention Outcomes Network RegistryGet With the Guidelines (ACTION RegistryGWTG) database, an in-hospital major bleeding risk model was developed in a population of patients with ST-segment elevation myocardial infarction and nonST-segment elevation myocardial infarction. The model used only baseline variables and was developed (n = 72,313) and validated (n = 17,960) in patients with AMI (at 251 United States centers from January 2007 to December 2008). The 12 most statistically and clinically significant variables were incorporated into the final regression model. The calibration plots are shown, and the model discrimination is demonstrated in derivation and validation cohorts, as well as across key subgroups. The rate of major bleeding in the overall population was 10.8%. The 12 factors associated with major bleeding in the model were heart rate, baseline hemoglobin, female gender, baseline serum creatinine, age, electrocardiographic changes, heart failure or shock, diabetes, peripheral artery disease, body weight, systolic blood pressure, and home warfarin use. The risk model discriminated well in the derivation (C-statistic = 0.73) and validation (C-statistic = 0.71) cohorts. A risk score for major bleeding corresponded well with observed bleeding: very low risk (3.9%), low risk (7.3%), moderate risk (16.1%), high risk (29.0%), and very high risk (39.8%). In conclusion, the ACTION RegistryGWTG in-hospital major bleeding model stratifies risk for major bleeding using variables at presentation and enables risk-adjusted bleeding outcomes for quality improvement initiatives and clinical decision making.
AB - Bleeding, a common complication of acute myocardial infarction (AMI) treatment, is associated with worse outcomes. A contemporary model for major bleeding associated with AMI treatment can stratify patients at elevated risk for bleeding and is needed to risk-adjust AMI practice and outcomes. Using the Acute Coronary Treatment and Intervention Outcomes Network RegistryGet With the Guidelines (ACTION RegistryGWTG) database, an in-hospital major bleeding risk model was developed in a population of patients with ST-segment elevation myocardial infarction and nonST-segment elevation myocardial infarction. The model used only baseline variables and was developed (n = 72,313) and validated (n = 17,960) in patients with AMI (at 251 United States centers from January 2007 to December 2008). The 12 most statistically and clinically significant variables were incorporated into the final regression model. The calibration plots are shown, and the model discrimination is demonstrated in derivation and validation cohorts, as well as across key subgroups. The rate of major bleeding in the overall population was 10.8%. The 12 factors associated with major bleeding in the model were heart rate, baseline hemoglobin, female gender, baseline serum creatinine, age, electrocardiographic changes, heart failure or shock, diabetes, peripheral artery disease, body weight, systolic blood pressure, and home warfarin use. The risk model discriminated well in the derivation (C-statistic = 0.73) and validation (C-statistic = 0.71) cohorts. A risk score for major bleeding corresponded well with observed bleeding: very low risk (3.9%), low risk (7.3%), moderate risk (16.1%), high risk (29.0%), and very high risk (39.8%). In conclusion, the ACTION RegistryGWTG in-hospital major bleeding model stratifies risk for major bleeding using variables at presentation and enables risk-adjusted bleeding outcomes for quality improvement initiatives and clinical decision making.
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U2 - 10.1016/j.amjcard.2010.12.009
DO - 10.1016/j.amjcard.2010.12.009
M3 - Article
C2 - 21324428
AN - SCOPUS:79953290683
SN - 0002-9149
VL - 107
SP - 1136
EP - 1143
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 8
ER -